Posted by linkadge on June 5, 2008, at 22:34:49
In reply to NEWBIE--My story (long, but please read!), posted by crazybeautiful on June 5, 2008, at 19:18:12
>A p-doc was downright rude to me when I asked >her about various meds I had researched.
Unfortunately, many doctors do not like being suggested which meds to prescribe. In some respects this can be benificial since one persons cure is another's poison. There is really no good way of knowing which patients will respond to which meds. It is generally a game of Russian Roulette.
>I guess >she felt insulted that I had some >knowledge on meds, therapy, & what might be >going on with me (I do since I'm planning on >majoring in Psychology & have taken some >classes).
Nothing wrong with doing research, but again what you read in psych textbooks is just general serotonin/norepinephrine hypothesis. There are also no tests for neurotransmitter levels, so its kind of a shot in the dark, even the notion that they are restoring low levels of certain monoamines is only a hypothesis that doesn't explain many things. I guess what I am saying is that even with the most detailed training in psychopharmachology it is still mainly a guessing game.
>One med made me tense & gave me bad muscle >spasms, & insomnia. Based on what others have >said, I'm guessing this was the Effexor XL. >Assuming that, the Geodon made me sleep about 12->14 hrs. & made me confused & disoriented. It was >awful!!
Some doctors prescribe antipsychotics (like geodon) for adjunctives in depression. They generally have a lot of side effects and their efficacy in depression is only marginally documented.
>At that time I was almost convinced I was >suffering from Borderline Personality Disorder & >Social Phobia because I certainly identified >with the requirements in the DSM-IV. After doing >blood work & having me cut down on caffeine, he >finally decided that maybe there was truth to >what I was saying. He diagnosed me with having >Dysthymia with Borderline Personality >tendencies. I disagree.
Sorry I don't follow. You said you felt that you identified with BPD.
>He put me on Paxil (forgot the mgs) & I was on >that for about 6 months. That just made me into >a sexless zombie who didn't care about anything. >I couldn't even cry.
Welcome to the wonderful world of antidepressants.
>I would scream & slam doors & physically abuse >him. I'd get so mad that I couldn't breathe & >would forget what I was mad about in the first >place. Then I'd collapse in exhaustion, tears >streaming down my face, & holding onto my >boyfriend saying "I'm sorry." I hated being like >this. I kept thinking that all of my boyfriends >were just incompatible. Maybe they were, but >with time I realized that my anger & sensitivity >were the majority of the problem.
Was this on paxil or off of it? How soon after discontinuing? After coming off SSRI's people can somtimes have a prolonged emotional rebounds. Ie the SSRI blunts all emotions and for a while afterwards the brain is extra sensitive to emotional stimulii.
Have you ever tried omega-3 fatty acids? There are studies suggesting them as adjunctives for depression bipolar and borderline. Studies suggest they reduce the stress induced release of cortisol which may benifit social anxiety (just a side note)
>Now I look back & realize that I've been like >this my whole life. Even when I was a child, I'd >get so mad at my mother, screaming & yelling at >her. My father did the same thing to her so I >imagine some of what I have is hereditary.Behaviors can get passed down in many ways, genes, behavioral modeling and epigenics. I'm sure you're aware.
>Mom is very loving, understanding, & laid back. >Dad is just the opposite--raging temper, >insomniac, slightly OCD, controlling. His mother >was bipolar, but we don't know all the details. >So with all of this, how could I not be manic >depressive or something of the sort?Its possible. The only thing that doesn't really fit though is your responce to paxil. Antidepressants usually worsen cycling in bipolar. They can also produce manic epsiodes especially when unaccompanied by an mood stabilizer. Its also about sevarity of sympoms. Rage and anger can be symptoms of depression.
For classic bipolar you'd be looking for symtpoms like extended periods of euphoria ie elevated mood for days at a time, loss of control over spending, racing thoughts, lack of need for sleep (ie sleeping 3 hours and feeling great) etc. etc.
Bipolar II is also a possibility if you experience hypomania as well as depression.
If symptoms like irritability improved with an antdiepressnat you might lean more towards a depression or dysthymia diagnosis. If the paxil worsened irriability, or caused cycling then this might be more indicative of bipolar.
Is it worsened or associated with PMS (Ie premestral dysphoric disorder)?
What you're going to find is that the DSM guidelines are not concrete devisions or categories. Some suggest the use of a more dynamic scale system where diagnosis is not about having or not having a disorder.
In terms of the DSM many psychiatrists probably think of a diagnosis secondary to a medication which may help the symptoms.
>I told them I was depressed, but angry. I >appeared hopeless & distraught because >this "cycle" of normal, angry, sad/ashamed, had >been going on so long. Immediately they >think "Oh, she's just depressed. This is easy."
Its hard to know. It is possabile that the anger is serving as a coping mechanism to help combat depression. This is fiarly common in depression.
>But my depression was obviously stemming from a >bigger problem which needed to be addressed. So >I went to my GP.
>I had not seen her very much since I only visit >when I'm sick, but I decided to give her a try. >I explained that I was angry & irritable all the >time & this was causing me to be depressed & >also that I had no energy & I had >social/performance anxiety. I was pleasantly >suprised, she was nice & willing to help as much >as she could. I had heard great things about >Lexapro, & she agreed & put me on 10 mg a day.
Again, lexapro is an SSRI. Sure its newer and more widely advertiesd these days but really no more effective than older AD's like say paxil.
The fact that lexapro works and paxil didn't is really a crapshoot. I have heard the same story as yours but the other way around (ie lex did nothing but paxil helped) so its really hard to know.>Then after the initial 2 weeks, things leveled >out the 3rd week. I went back to report to GP >about my progress. I mentioned the sexual side >effects & she said we could always add >wellbutrin later to take care of that, but to >stay with the 10 mg for another month. By the >end of the second month, I hit rock bottom. I >got soooo depressed, like really depressed for >no reason & I was really sensitive. I didn't get >angry, just sad over the smallest things.
Again, welcome to the wonderful world of antidepressants! Sometimes they work great and then just poop out. There are a number of theories as to why this happens. It can simply be pharmachological tollerance, i.e. the brain starts to produce more serotonin transporters to compensate for those inhibited by the drug. It could be bipolar, but again, drug induced behavior is exactly that - drug induced behavior. So many people react to these drugs in a similar way.
>Back to GP for another progress report, this >time she ups me to 20mg of Lexapro & asks if I >wanna add the Wellbutrin XL. I told her I'd wait >& see what happens first. I took the 20mg of >Lexapro for a month. As usual, first 2 weeks I >was on a high again. Beginning of the 3rd week I >leveled out & by the end of the 3rd week I was >so fatigued that I slept 10 hrs. a day & still >needed naps.
One theory suggests that proloned SSRI administration squelches out the production/release of dopamine, leaving the user fatigued and apatheic over time.
>During this time my GP decides to quit! I >freaked! I was hesitant about going to the >replacement doc, but I gave it a shot. Luckily, >she was even nicer & better than my original GP. >She also suggested adding Wellbutrin XL & said >it would help the sexual side effects, >counteract the fatigue, give me motivation
>(which I've had a problem with my entire life) & >even help me cut down on smoking! So I added the >150mg Wellbutrin XL. I said to myself, uh oh, >here we go, I'm getting a cocktail going. I hope >this doesn't turn out to be a 6 or 7 ingredient >cocktail before this is all over, but I remained >optimistic. I took the 150mg of Wellbutrin XL in >the mornings & the 20mg of Lexapro in the early >evenings. Wah-lah! Within a week I was back to >having great sex. ;) Within 2 weeks I saw some >improvement in my fatigue. I didn't notice any >improvement in motivation or smoking cessation. >In fact, by this time I had noticed that the >Lexapro was making me smoke more & drink more, >but I didn't care since it was working so well >on my rage & social/performance anxiety.>So back to the new GP to report on progress. She >decides to up me to 300mg to see if that solves >everything. I take my cocktail & wah-lah! >Motivation like I've never had before! >Wonderful! Then, as time passes, I start getting >irritable. Oh no! Not THIS again! I will NOT go >back to being like that! I also develop a tic in >my jaw & have some random muscle spasms other >places like arms & legs. They happen in spurts & >last just about every 2-10 minutes. They will go >away for a while & come back again for 2-10 >minutes or so. VERY annoying. I can be talking & >my jaw will move involuntarily so I kind of >stutter. Really embarrassing. I even bit my >tongue a few times. I had noticed the tic & >spasms happening a little on the 150mg towards >the end of the month, but I figured they might >go away with time or changing the dose.
>So back to GP again. I get lowered back down to >150mg, but this time it's Buproprion SR instead >of XL. Nurse Practioner (GP was out of town) >says to take 75mg in the morning & take my >Lexapro 20mg in the evening. If I find that I >need more Buproprion take another one before 5pm >(or else I won't be able to sleep). Well, it's >been about 3 weeks now & here I am, typing to >you guys. Why? Because the Buproprion SR is not >working. Even at 75mg I am twitching like a >rabbit & I just can't stand it. I'm also >noticing a bit more fatigue & a little >irritability. Based on what I've told you, does >anyone have a clue as to what my diagnosis might >be? I know you aren't professionals, but I'd >still like to hear your opinions. Also, has >anyone been on this Lexapro-Wellbutrin cocktail? >Do you have any suggestions as to what meds I >should try? I've heard some good things about >Privigil, & Inderal.
It *might* be bipolar, but I'd be more inclined to say you responces are typical. lexapro/wellbutrin combination is basically a low grade version of cocaine. Some research shows that the brain adapts to these drugs like it does to drugs of abuse.
You could go on a mood stabilizer but that will do jack for low enegery levels. It will also not give you anywhere near the umph that an AD does. AD's 'poop out' that the unfortunate reality. Psychiatrists don't admit to that but it still happens.
You had a good initial responce to the lexapro. Why not go back to just lexapro. If it makes you tired or apathetic then just lower the dose. Thats my best advice. If you get into a cocktail, things will get complicated, messy, neurotoxic and not necessarily any better. Provigil is an option, but you may want to get off the wellbutrin first.
Do you take vitamins? How is your b12 status? The amino acid tyrosine may be an option.
How is your thyroid? Low thyroid can cause depression, low energy, and irritability.
>Could either of these be a substitute for the >Wellbutrin, taken along with the Lexapro? All >responses welcomed.
Provigil may help energy but its probably not going to do much for social anxiey or performance anxiety. Its really an alertness promoting agent not a motivation enhancing agent.
I'd recomend dropping the wellbutrin, lowering the lexapro to 5 or 10mg. Adding some b12 (say 10-50mg), folic acid (400mg), omega-3 (300epa, 300dha).
These are the building blocks to the neurotransmitters that may be low. The drugs really only work to recycle the available amount of neurotransmitter, sometimes they can exaserbate the depeletion.
Try to limit smoking. Nicotine may exaserbate a catecholamine deficiancy.
Also check thryroid if you have not already.
Linkadge
poster:linkadge
thread:833193
URL: http://www.dr-bob.org/babble/20080528/msgs/833220.html